Thiago Silva Torres

Sexual and gender diverse (SGD) populations have historically faced restricted rights and systematic discrimination for deviating from the established hetero-cis-normative norms. This long-standing marginalization has a profound negative impact on health outcomes, including a heightened risk of developing mental health issues, such as depression. Understanding the health-disease process among SGD populations requires recognizing that discriminatory experiences, such as homophobia and transphobia, are not unidimensional, but operate synergistically with layered forms of discrimination, such as racism. We assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) among SGD persons in Brazil using race as a stratification variable. We also evaluated the role of discrimination and internalized homonegativity on depressive symptoms, while adjusting for covariates. This was a cross-sectional online survey recruiting SGD persons aged 18 years or older, living in Brazil, through dating apps and social media. Overall, 6220 participants were included, 3749 (60.3%) White, 1685 (27.1%) Pardo and 786 (12.6%) Black. Mean scores of depressive symptoms was 8.8 (SD7.1), higher among Black (9.6; SD 7.5) and Pardo (9.3; SD 7.2) than White (8.4; SD7.0) (p < 0.0001). Considering a PHQ-9 cut-off of ≥10 points, more Black and Pardo participants reported depressive symptoms than White participants (38.5%, 38.1%; 32.3%, respectively). In multivariable linear regression models, higher discrimination score and younger age were associated with higher scores of depressive symptoms for all races. Additionally, internalized homonegativity and lower income were associated with higher depressive symptoms scores for Pardo and White, but not for Black participants. To effectively address vulnerability to depression among SGD populations, it is essential to establish approaches that consider the intersections between different forms of oppression. This includes policies that tackle racism, homophobia, and transphobia, as well as investment in accessible mental health services.

Introduction: The availability of highly efficacious HIV pre‐exposure prophylaxis (PrEP) makes it unethical or infeasible to conduct inactive/placebo‐controlled trials to evaluate new HIV prevention options. As a result, randomized active‐control non‐inferiority trials are typically employed; however, they require large sample sizes and extended follow‐up. Moreover, their results can be hard to interpret. An alternative approach compares HIV incidence among individuals receiving a new PrEP product to a counterfactual incidence estimate—an estimate of what the HIV incidence would have been in the absence of PrEP. Methods: We leveraged data from three studies (AMP, Sabes and ImPrEP seroincidence) conducted among men who have sex with men and transgender persons in Lima, Peru, between 2013 and 2022 to estimate the counterfactual HIV incidence for two target populations represented by a clinical trial (AMP) and a non‐interventional cohort study (Sabes). We evaluated three estimation methods: prospective cohort follow‐up, recency testing and rectal gonorrhoea (RG) approaches. These approaches were compared directly using data from the same study, and we further assessed population adjustment approaches by comparing estimates across studies. Results: All three methods produced consistent HIV incidence estimates when applied to data collected from the same study. However, estimates differed when data from external studies were used, even after propensity score (PS) adjustment. For example, estimates for the AMP population using Sabes or ImPrEP data remained higher than the AMP gold‐standard estimate. In contrast, adjusted estimates for the Sabes population using AMP or ImPrEP data were lower than the Sabes follow‐up estimate. These differences underscore the challenges of applying external data and highlight the role of unmeasured population heterogeneity. Conclusions: Counterfactual HIV incidence estimates can support evaluation of new PrEP agents when direct placebo comparisons are not possible. Estimates from recency‐testing and RG approaches are promising when prospective follow‐up is infeasible, but their validity depends on data quality and population similarity. PS methods improve comparability across populations but cannot fully account for unobserved differences. Triangulating across methods and sources can improve confidence in counterfactual estimates, which should be interpreted with careful attention to population context.

Food insecurity has re-emerged as a critical issue in Brazil, significantly worsened by the COVID-19 pandemic. We recruited Brazilian sexual and gender diverse (SGD) persons aged 18 + years on apps and social media across three periods: early (2020), late (2021), and post-COVID-19 (2024) pandemic. We explored two outcomes: food insecurity (all participants) and antiretroviral (ART) nonadherence (only persons living with HIV). Food insecurity was assessed using the 8-item version of the Brazilian Household Food Insecurity Measurement Scale. ART nonadherence was defined as reporting < 100% medication adherence in the past 30 days. Logistic regression models assessed factors associated with each outcome. In total, 22,327 participants were included (74.6% HIV-negative; 17.9% living with HIV, 7.5% HIV-unknown), mean age 37 years, 96.3% cisgender men. Compared to the early pandemic period, lower odds of experiencing food insecurity were observed for late (adjusted odds ratio [aOR]:0.65, 95% confidence interval [CI]:0.59–0.71) and post-pandemic (aOR:0.66, 95%CI:0.60–0.73) periods. Participants who reported to be living with HIV had higher odds of experiencing food insecurity (aOR:1.21, 95%CI:1.11–1.31). Food insecurity increased the odds of ART nonadherence (aOR:2.36, 95%CI:1.57–3.63). Compared to early pandemic period, late (aOR:2.69, 95%CI:1.81–4.09) and post (aOR:3.61. 95%CI:2.49–5.39) pandemic periods were associated with higher odds of ART nonadherence. Our study shows food insecurity as a critical barrier to optimal ART adherence among Brazilian SGD living with HIV. Although the experience of food insecurity decreased in the two most recent periods, its enduring association with HIV infection and ART adherence underscores the urgent necessity for comprehensive and integrated public policies.

Hepatitis C virus self-testing (HCVST) has emerged as a potential strategy to expand testing among key populations. We assessed the feasibility of HCVST in cisgender men-who-have-sex-with-men (cis-MSM) and transgender women (TGW) on pre-exposure prophylaxis (PrEP). This cross-sectional study included cis-MSM or TGW attending a PrEP consultation in Rio de Janeiro (Brazil). Participants performed HCVST using blood-based and oral-fluid kits on the same day under observation. Difficulties, errors and assistance during HCVST were recorded. Re-reading and re-testing concordance [Kappa(k)] and values/preferences were assessed. A total of 250 participants (88% cis-MSM, age = 34 [IQR,28–41] years, 42% with high education level) were included. The main steps where participants requested assistance (95%CI) for blood-based HCVST were to add buffer [35.6%(29.9–41.8)] and to collect blood sample with the dropper [34.0%(28.4–40.1)]. The main error during oral fluid HCVST was incorrect collection of oral fluid [29.6% (95%CI,24.2–35.6)]. A total of 62.4% (95%CI,56.2–68.2) and 28.8% (95%CI,23.5–34.8) participants needed assistance in at least one step of blood-based and oral fluid HCVST, respectively. Lower education level was associated with higher odds of needing assistance for blood-based HCVST [aOR = 2.07 (95%CI,1.99–3.59), p = 0.009]. Re-reading and re-testing k-indexes were 0.92 and 0.89 for blood-based, and 1.00 and 0.75 for oral fluid HCVST, respectively. More than 95% of people felt safe; would repeat or would recommend HCVST. A total of 46.4% (95%CI,40.3–52.6) preferred oral fluid versus 36.4% (95%CI,30.6–42.6) who preferred blood-based. A relatively high proportion of participants needed assistance, especially for blood-based HCVST. Despite these challenges, high re-reading and re-testing agreements were observed and HCVST was well-accepted.

Suppression of HIV with antiretrovirals eliminates HIV transmission risk, summarized as Undetectable = Untransmittable (U = U). However, U = U literacy remains unevenly understood and shared, and stigmas persist. Equitable and accurate awareness of U = U requires culturally tailored interventions, improved provider education, and supportive policy environments beyond biomedical evidence alone.